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If my experience were a script for Clint Eastwood, the title would be, "The High-5, the Good, & the Bad." I have not experienced what some other vets unfortunately have, " . . . , & the Ugly."

After graduating from college and my 2 ½ year stint in the Peace Corps in Colombia, and during the early U.S. buildup in Vietnam, I volunteered for the US Army and the Army's Special Forces ("Green Berets"), received intensive one year training as a Special Forces Independent Duty Medic to function as a physician where there was none, and was in Vietnam for two one-year tours. My four years of service did not result in any need for health care after discharge in December, 1968.

My experiences as an Independent Duty Medic in Vietnam did, however, result in a strong desire to be a real physician. After completing the premed science requirements, I was accepted by the University of Washington (UW) School of Medicine, Seattle, in September 1970, and then UW Family Medicine Residency. Part of that Residency included two months on the Internal Medicine [End Page 90] Service of the Seattle VA Hospital that was affiliated with the UW. The Director of that Service, who was also the Attending Physician with whom we residents met every day, was one of the most humane Attending Physicians I had during my three year Residency. He taught and practiced not only medical science but also compassionate medical caring for the VA's patients.

After residency in 1977, I entered the Public Health Service (PHS), specifically the Indian Health Service. PHS is a "Uniformed Service," and thus I was eligible to receive care at military and VA hospitals.

Fast forward to 1998. That year I was found to have a slightly elevated PSA test—"Prostate-Specific Antigen," indicating possible prostate cancer—during episodic medical care for other reasons at the U.S. Naval Hospital in Bethesda while on temporary duty nearby. I went to the combined university + VA hospital near my permanent duty station in the Southwest. The faculty-doctor had a reassuring patient-doctor manner. The six prostate needle biopsies were done in late July by the Urology Chief Resident there—he had just started his year as Chief Resident. The results included one biopsy lost and the others inconclusive. I asked to be seen by the Prostate Cancer Program at the Walter Reed Army Medical Center, a program with a superb reputation. The doctor I saw there instilled confidence—and did 13 prostate biopsies with great skill. The biopsies were read by the Walter Reed pathologists; they disagreed among themselves on the interpretation and thus sent the biopsies to the next-door Armed Forces Institute of Pathology, the premier pathology institute whose readings were the gold standard in pathology. Final diagnosis: early prostate cancer.

I had to decide which possible treatment to do: surgery (prostatectomy to remove the whole prostate); radiation therapy (kill the prostate and its cancer by radiation from outside the body); brachytherapy (insert several radioactive small pellets to kill the prostate and its cancer from the inside); or "watchful waiting" (follow PSA tests, to do an active treatment only if the PSA progressed higher). I, was 57 years old; my wife Carolyn and I decided against "watchful waiting."

I visited a physician in charge of each type of active treatment. The first was the head of urological surgery at the same university + VA hospital in the Southwest. He maintained no eye contact with me, staring at my medical chart as he recited his information non-stop for me (i.e., what the prostatectomy would be, its recovery time, and why it would be the best treatment option for me). I did not go back. Instead, regarding the surgical option, I met with the urological surgeon at Walter Reed who had done my 13 biopsies; I then met with the doctor in charge of Radiation Therapy at Walter Reed. Both visits had a more gratifying doctor-patient interaction.

A pioneer of brachytherapy treatment for prostate cancer and research about its results had recently moved from Memorial Sloan Kettering Cancer Center in New York City to the Seattle VA Hospital. In my visit to him, he took much time to explain the pros and cons of brachytherapy, and his and other's documented results with real interpersonal interest and contact. I preferred brahchytherapy, and wanted him to do it, and Carolyn agreed.

Pre-op at the Seattle VA was fine, quick, professional, and friendly. When I woke up in the Recovery Room (with Carolyn there), I was freezing, asked for another blanket, and only slowly warmed up. I wondered ever since why the Seattle VA Recovery Room was so cold—didn't other people in recovery there complain?

My most recent extended health care experience was in 2008, a 10-month-long evaluation to be a non-directed living kidney donor by the Swedish Medical Center in Seattle and then the surgery itself. It was a superb experience—especially when, in my first meeting with my surgeon, he assured and convinced me that I was his patient, not the intended recipient of my kidney. He also took me to see the CT scan, in color and 3-D, of my blood vessels and kidneys; Wow! How far has CT scanning come from when it first arrived during my medical school years! I also found the answer to the question I had wondered about since 1998: I woke up in the Swedish Recovery Room . . . freezing.

My surgeon joked with Carolyn and me post-op: "Your arteries and kidneys are so good, when do you want to donate your other kidney?" (Answer: [End Page 91] "Not for a while!") The surgeon who transplanted the (formerly my) kidney into the recipient visited, and told us that the kidney started to produce urine even before he had a chance to connect the ureter. High-five indeed!

Over the past 48 years since my military service, I have been the beneficiary of the finest medical science—from the expertise of the world famous Armed Forces Institute of Pathology, to the advance of treatment for prostate cancer by brachytherapy, to the superscience of transplantation that still is benefitting the recipient of (now) her "pre-owned" kidney—and that benefitted me by allowing me to be a living organ donor, truly a privilege. I have been the beneficiary as well of exceptional medical caring from the Walter Reed urology surgeon to the brachytherapy physician in the Seattle VA to the entire kidney transplant team at Swedish Medical Center—and especially my surgeon who removed my kidney.

I am also sure that I, being a physician, sometimes received more attention when a patient than did most patients in that same situation. Yet, even I occasionally have experienced the too frequent downsides in medical science in health care, such as the somewhat increased problems that occur when the new, inexperienced, interns and residents in teaching hospitals first start in July, and procedural errors. (I hope my mistakes when starting Family Medicine Residency did not harm my patients.) And, in my visit with the first prostatectomy surgeon, I experienced as well a poster experience of anti-personal "health care delivery." (What an uncaring phrase!)

William L. Freeman
US Army 5th Special Forces Group, in Vietnam 1967 & 1968

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